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This article discusses the results of the May Measurement Month (MMM) 2019 campaign, which contributed to a third round of MMM hypertension screening campaigns carried out in Albania, a transitional country in the Western Balkans. The hypertension screening campaign in Albania was carried out during the period 1–31 May 2019 in 30 sites in many districts of the country. Overall, 19 154 participants aged ≥18 years were included (approximately 68% of these were women), with an overall mean age of 47.0 ± 15.3 years. Blood pressure (BP) was measured with OMRON sphygmomanometers (Omron Healthcare, Kyoto, Japan). Hypertension was defined as systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg, or on treatment for hypertension. Self-reported data consisted of height and weight, pre-existing conditions, including smoking status and alcohol consumption. Overall, the proportion of participants with hypertension was 38.6%. Less than two-thirds (64.7%) of hypertensive individuals were aware of their condition. Also, less than half (48.3%) of participants on antihypertensive medication had controlled BP (

This article reports on May Measurement Month (MMM) 2018, which consisted of the 2nd round of the hypertension screening campaign conducted in Albania, a former communist country in South Eastern Europe. The hypertension screening campaign in Albania was conducted during the period 13–31 May 2018. Overall, there were eight sites from seven districts of the country involving 7046 participants aged ≥18 years (61% women and 39% men; overall mean age 46.8 ± 15.7 years). Blood pressure was measured with OMRON sphygmomanometers (Omron Healthcare, Kyoto, Japan). Hypertension was defined as systolic blood pressure (SBP) ≥140 mmHg, or diastolic blood pressure (DBP) ≥90 mmHg, or on treatment for hypertension. Self-reported information included height and weight, diabetes, smoking status, and alcohol intake. The proportion of participants with hypertension was 37.2% of whom only 52.1% exhibited awareness. Furthermore, only a quarter of hypertensive individuals were properly treated and controlled. Significant predictors of high SBP and/or high DBP included a previous diagnosis of hypertension, being on antihypertensive medication, frequent alcohol intake, and being overweight and obese. The MMM 2018 campaign in Albania had a unique value for early detection of hypertension, particularly among younger adults. Policymakers and decision-makers in Albania and elsewhere should also rely on the MMM screening campaigns which have a great potential for prevention and control of hypertension in the general population.

Objectives: Our study aims to assess whether multimorbidity is an independent risk factor for the development of depression in older adults living in Canada, Brazil, Colombia, and Albania and exami...

Evidence about the magnitude and determinants of medication intake adherence among patients and the general population in Southeastern Europe is scant.To assess the prevalence and sociodemographic correlates of medication intake adherence among adult primary health-care (PHC) users in Albania.A cross-sectional study was conducted in 2018-2019 in a representative sample of 1553 adult PHC users (response: 94%) selected probabilistically from 5 major regions of Albania. There were 849 (55%) women and 704 (45%) men, with a mean age 54.6 (16.4) years. A structured interviewer-administered questionnaire inquired about medication intake adherence prescribed by family physicians, and sociodemographic characteristics. Binary logistic regression was used to assess the sociodemographic correlates of medication intake adherence.Three hundred (19.8%) participants did not take the prescribed medication. In multivariable-adjusted logistic model, significant correlates of nonintake of medication included rural residence, low educational level, unemployment and low economic level. Among these 300 participants, 273 (91%) considered the high cost of the drugs as a reason for not taking the medication.We found a high prevalence of nonintake of medication prescribed by family physicians. Decision-makers and policy-makers in Albania and elsewhere should consider the provision of essential drugs free of charge or at low cost to low socioeconomic groups and other vulnerable and marginalized population categories, because the costs of noncompliance will eventually be higher.الانتشار والارتباطات الاجتماعية السكانية للالتزام بتناول الدواء بين مستخدمي الرعاية الصحية الأولية في ألبانيا.دجانا روشي، جينك بورازيري، سالفاتوري إيطاليا، بيتر شرودر-بيك، ألبان إيلي، هيلموت براند.لا توجد أدلة تُذكر على حجم الالتزام بتناول الدواء ومحدداته بين المرضى وعموم السكان في جنوب شرق أوروبا.هدفت هذه الدراسة إلى تقييم مدى الانتشار والارتباطات الاجتماعية السكانية للالتزام بتناول الدواء بين مستخدمي الرعاية الصحية الأولية في ألبانيا.أُجريت دراسة مقطعية في عامي 2018-2019 على عينة مُثِّلة ضمت 1553 من مستخدمي الرعاية الصحية الأولية من البالغين (الاستجابة: 94٪) وقد اختيروا باحتمالية من 5 مناطق رئيسية في ألبانيا. واشتملت العينة على 849 امرأة (55٪) و 704 رجلً (45٪)، وبلغ متوسط أعمارهم 54.6 سنة (16.4). واستفسر استبيان منظم يديره محاور عن الالتزام بتناول الأدوية الموصوفة من أطباء الأسرة، والخصائص الاجتماعية السكانية لذلك. واستُخدم الانحدار اللوجستي الثنائي لتقييم الارتباطات الاجتماعية السكانية للالتزام بتناول الدواء.لم يتناول ثلاثمائة مشارك (19.8٪) الدواء الموصوف. وفي النموذج اللوجستي المُعدَّل متعدد المتغيرات، اشتملت الارتباطت المهمة لعدم تناول الدواء على الإقامة الريفية، وانخفاض المستوى التعليمي، والبطالة، وانخفاض المستوى الاقتصادي. ومن بين المشاركين البالغ عددهم 300 شخص، اعتبر 273 (91٪) ارتفاع تكلفة الأدوية سببًا لعدم تناولها.وجدنا ارتفاع معدل انتشار عدم تناول الأدوية التي يصفها أطباء الأسرة. وينبغي لصناع القرار وصناع السياسات في ألبانيا وفي أماكن أخرى أن ينظروا في توفير الأدوية الأساسية مجانًا أو بتكلفة منخفضة جدًا للفئات الاجتماعية الاقتصادية المنخفضة وغيرها من الفئات السكانية الضعيفة والمهمشة، لأن تكاليف عدم الامتثال ستكون أعلى في نهاية المطاف.Prévalence et corrélats sociodémographiques de l'observance thérapeutique chez les usagers des soins de santé primaires en Albanie.Les données sur l’ampleur et les déterminants de l’observance thérapeutique chez les patients et dans la population générale en Europe du Sud-Est sont rares.Évaluer la prévalence et les corrélats sociodémographiques de l'observance thérapeutique chez les usagers des soins de santé primaires adultes en Albanie.Une étude transversale a été menée en 2018-2019 auprès d'un échantillon représentatif de 1553 adultes usagers des soins de santé primaires (taux de réponse : 94 %) sélectionnés de manière aléatoire dans cinq grandes régions d'Albanie. Il s’agissait de 849 femmes (55 %) et 704 hommes (45 %), dont l’âge moyen était de 54,6 ans (16,4). Un questionnaire structuré administré par un enquêteur a permis de s'enquérir de l'observance thérapeutique pour les médicaments prescrits par les médecins de famille, et des caractéristiques sociodémographiques. La régression logistique binaire a été utilisée pour évaluer les corrélats sociodémographiques de l’observance thérapeutique.Trois cents participants (19,8 %) n'ont pas pris les médicaments prescrits. Dans le modèle logistique ajusté multivarié, les corrélats significatifs de la non-prise de médicaments comprenaient la résidence rurale, le faible niveau d'éducation, le chômage et le faible niveau économique. Parmi ces 300 participants, 273 (91 %) ont considéré le coût élevé des médicaments comme une raison de ne pas les prendre.Nous avons constaté une forte prévalence de la non-prise de médicaments prescrits par les médecins de famille. Les décideurs et les responsables de l’élaboration des politiques en Albanie et ailleurs devraient envisager la fourniture de médicaments essentiels gratuitement ou à un coût très bas pour les groupes à faible revenu et les autres catégories de population vulnérables et marginalisées, car le coût de la non-observance sera en fin de compte plus élevé.

Background: Determinants of hypertension diagnosis and/or awareness and control among older adults are understudied in Albania, a former communist country in South Eastern Europe, which is experiencing rapid demographic, socioeconomic and epidemiological transition. This paper examines the association of individual, interpersonal, organizational and community factors with hypertension awareness and control among older adults in Tirana, the Albanian capital. Methods: Using 2012 International Mobility in Aging Study data on older adults from Albania's capital city (n = 393) and the socioecological model as a conceptual framework, multinomial regression models identified factors associated with controlled, uncontrolled and undiagnosed hypertension. Results: For hypertension, 17.3% participants had none, 23.4% were controlled, 48.4% were uncontrolled and 10.9% were undiagnosed/unaware. Compared to those with controlled hypertension, in multivariable models, a high level of friend support was negatively associated with uncontrolled (OR: 0.4; 95% CI: 0.2-0.9) and undiagnosed (OR: 0.2; 95% CI: 0.1-0.6) hypertension. A high level of perceived neighbourhood safety was negatively associated with uncontrolled (OR: 0.6; 95% CI: 0.3-1.0) and undiagnosed (OR: 0.4; 95% CI: 0.2-1.0) hypertension. Compared to those with no hypertension, children's social support was positively associated with uncontrolled (OR: 2.2; 95% CI: 1.1-4.3) and undiagnosed (OR: 3.6; 95% CI: 1.3-9.6) hypertension. Conclusion: This study provides new insights about distinct risk factors for inadequate hypertension management in Albania. It highlights the importance of community-level factors (safety) and interpersonal factors (family and friend ties) to hypertension diagnosis/awareness and control, which may provide novel intervention opportunities for hypertension programs.

Albania is a small country on the Balkan Peninsula that recently implemented an innovative primary healthcare program called “Si Je?” (How are you?) which allowed all Albanians aged 40–65 years to receive a free, yearly basic health examination at their local health center. Access to basic primary care is a critical component of a nationwide culture of prevention particularly for the non-communicable diseases that comprise 89% of total deaths in the country. Yet, as in many middle-income countries, a culture of prevention in Albania is often secondary to ensuring basic health infrastructure and healthcare access for those critically in need. Using the social-ecological model as our conceptual framework, this paper provides new insights into the culture of prevention in Albania by analyzing the need for, and implementation of, the Si Je? program using (1) findings from a critical literature review, (2) quantitative data from the database created from this program, and (3) qualitative data from key informant interviews from 15 health center directors. Positive developments towards a culture of prevention include the fact that the Si Je? program has been expanded to those 35–70 years, strengthened links between community and primary care, and participation among rural communities who traditionally have limited primary care access. Challenges include continued urgent health infrastructure needs, politicization of the Si Je? effort, limited participation by some groups (particularly urban men), and regional variations. Despite challenges, Albania appears to be building new infrastructure for a sustainable culture of prevention, particularly around chronic disease.

Background fear of falling (FOF) is a major health concern among community-dwelling older adults that could restrict mobility. Objective to examine the association of FOF with life-space mobility (i.e. the spatial area a person moves through in daily life) of community-dwelling older adults from five diverse sites. Methods in total, 1,841 older adults (65-74 years) were recruited from Kingston, Canada; Saint-Hyacinthe, Canada; Tirana, Albania; Manizales, Colombia and Natal, Brazil. FOF was assessed using the Fall Efficacy Scale-International (FES-I total score), and the life space was quantified using the Life-Space Assessment (LSA), a scale that runs from 0 (minimum life space) to 120 (maximum life space). Results the overall average LSA total score was 68.7 (SD: 21.2). Multiple-linear regression analysis demonstrated a significant relationship of FOF with life-space mobility, even after adjusting for functional, clinical and sociodemographic confounders (B = -0.15, 95% confidence interval (CI) -0.26 to -0.04). The FOF × site interaction term was significant with a stronger linear relationship found in the Canadian sites and Tirana compared with the South American sites. After adjusting for all confounders, the association between FOF with LSA remained significant at Kingston (B = -0.32, 95% CI -0.62 to -0.01), Saint-Hyacinthe (B = -0.81, 95% CI -1.31 to -0.32) and Tirana (B = -0.57, 95% CI -0.89 to -0.24). Conclusion FOF is an important psychological factor that is associated with reduction in life space of older adults in different social and cultural contexts, and the strength of this association is site specific. Addressing FOF among older adults would help improve their mobility in local communities, which in turn would improve social participation and health-related quality of life.

Background Elderly persons make greater use of psychotropic drugs, but there are few international studies on social differences in the use of these medications. The aim of this study is to examine social differences in the use of psychotropic drugs among persons aged 65–74 years in the International Mobility in Aging Study (IMIAS). Methods The sample consisted of 1,995 participants in the IMIAS 2012 baseline study in Saint-Hyacinthe (Canada), Kingston (Canada), Tirana (Albania), Manizales (Colombia), and Natal (Brazil). During home visits, all medication taken by the participants in the previous 15 days was recorded. We then used the Anatomical Therapeutic Chemical classification system to code psychotropic drugs as anxiolytics, sedatives, hypnotics (ASH); antidepressants (ADP); or analgesics, antiepileptics, or antiparkinsonians (AEP). Prevalence ratios for psychotropic drug use according to sex, education, income, and occupation were estimated by fitting a Poisson regression and controlling for demographic and health covariates. Results Psychotropic drug use was higher among Canadian participants than among those living outside Canada. Prevalence of AEP drug use was higher for women than men in the Canadian and Latin American sites. In Tirana, antidepressant drugs were rarely used. Socioeconomic differences varied among sites. In the Canadian cities, low socioeconomic standing was associated with higher frequency of psychotropic drug use. In the Latin American cities, elderly people with high education and income levels showed a higher level of antidepressant drug use, while people with manual occupations had a higher use of AEP drugs. In Tirana, ASH drug use was higher among those with low income. Conclusion An inverse association was observed between socioeconomic standing and psychotropic drug use in Canada, while the opposite was true in Latin America. Albania was notable for an absence of antidepressant use and greater use of ASH drugs among low-income groups.

After >10 years without detection of any cases of wild virus-associated poliomyelitis, a large outbreak of poliomyelitis occurred in Albania in 1996. A total of 138 paralytic cases occurred, of which 16 (12%) were fatal. The outbreak was due to wild poliovirus type 1, isolated from 69 cases. An attack rate of 10 per 100,000 population was observed among adults aged 19-25 years who were born during a time of declining wild poliovirus circulation and had been vaccinated with two doses of monovalent oral poliovirus vaccines (OPVs) that may have been exposed to ambient temperatures for prolonged periods. Control of the epidemic was achieved by two rounds of mass vaccination with trivalent oral poliovirus vaccine targeted to persons aged 0-50 years. This outbreak underscores the ongoing threat of importation of wild poliovirus into European countries, the importance of delivering potent vaccine through an adequate cold chain, and the effectiveness of national OPV mass vaccination campaigns for outbreak control.

BACKGROUND: Albania, as with all Central and Eastern European countries whose health systems were highly centralized, has undertaken a number of reforms aiming to transform, among many items, the financing and delivery of primary health care services. OBJECTIVE: This study assesses the practice activities of general practitioners working in the region of Tirana, over a period of 12 months. METHODS: Production is measured by the number of monthly visits carried out by the practitioner, and practice profiles are determined by referral rates for specialist care and prescription rates per visit. Multi-level regression analyses, taking into account the hierarchical structure of the data, were performed to identify the factors associated with productivity and profiles of practice. RESULTS: Results show large urban-rural variations with respect to practice conditions, characteristics of practitioners, productivity, and profiles of practice. Productivity was weak in the city of Tirana (an average of 277 monthly visits), 18% of patients were referred to specialists, and 66% received prescriptions. In rural areas, productivity was weaker (an average of 179 monthly visits), referral rates were lower (11%), and the prescription rate was 74%. In urban and rural areas, productivity and profiles of practice were related to the characteristics of both the client and the health centre and to the type of practice. CONCLUSION: There are only a few available epidemiological studies documenting the ongoing health transition and the concomitant increase in demand for primary health care services; therefore, we are unable to (causally) link the reported low productivity of general practitioners with population needs. Physician productivity and patient care is better for certain groups and in health care settings where a wide range of services and sophisticated medical technologies are available. The capacity to efficiently plan for medical manpower is limited–this may be attributed to deficiencies of the patient registration system on the lists of physicians who are paid on the basis of capitation. Additional studies examining utilization of health services, and satisfaction of patients and providers, is needed in order to provide sound recommendations for improving Albania’s health care system.